Operation of spinal canal stenosis

Surgical therapy

Surgical therapy is reserved for the very severe cases of spinal canal stenosis. The reason for surgery may be:

  • Unbearable, conservatively uncontrollable pain
  • Neurological symptoms of failure
  • Disability/Inability to work
  • Circumscribed spinal canal stenosis
  • Young patient age

What surgical procedures are available for this?

The therapy of choice for a circumscribed spinal canal stenosis would be open microsurgical decompression. Microsurgery is understood to be open surgery with a very small skin incision, the use of an operating microscope and special angled instruments. Under microscopic magnification, those parts responsible for spinal canal stenosis/nerve root stenosis are removed, i.e. decompressed (vertebral arch parts, ligamentum flavum parts, vertebral joint parts).

The surgical trauma is thereby limited to the most necessary. Advantages of the microsurgical procedure in the operation of spinal canal stenosis are In the case of a long-distance spinal canal stenosis over several vertebral levels, the incision must be widened, corresponding to an open surgery. For individual decompression steps, the surgical microscope is then used again.

If there is pronounced instability of the vertebral body at the same time as the spinal canal stenosis, the unstable spinal levels must also be stabilized during surgery. This can be done in different ways, possibly a two-stage operation with one intervention from the front and one from the back (abdominal and backward) is necessary. Sometimes a single operation from behind is also sufficient. The final result is a stiffening of the spine (spondylodesis).

  • Minor surgical trauma, thus less blood loss and less scarring.
  • Possibility of early mobilization and rehabilitation.
  • Fewer nerve and vessel injuries.
  • Maintaining stability in the mobile segment

Operation with or without stiffening?

It is not possible to say in general whether spinal canal stenosis surgery with or without stiffening is better. The advantage of stiffening is that it increases the stability of the affected spinal segment and thus, if necessary, the spinal canal can also be more effectively stopped. However, this occurs at the expense of mobility, which is usually better without stiffening.

In addition, the stiffening can also cause long-term complaints, especially pain. Therefore, as far as possible, stiffening is avoided. However, if there is a threat of bone instability, stiffening may be unavoidable.